Concierge Models Provide Physicians with Options

JULY 14, 2009

Ed Rabinowitz

From real estate to the job market, the current recession has impacted just about everyone and every segment of the economy. However, according to an article in the New York Times, concierge medical practices, while certainly not recession proof, do not appear to have been impacted as severely as might have been expected. Consumers/patients are still forking over $1,500 per year and up for what is promised to be personalized care and around-the-clock access.

According to Scott Golden, chief financial officer of the health benefits firm Golden & Cohen, for physicians with a loyal following, the opportunity exists through the concierge model to make equal or more money than before, see fewer patients, and practice medicine the way they want. And he expects that trend to continue.

“One of the goals of the Obama Administration is to get the uninsured in the system,” Golden says. “That means more people and probably the same amount of doctors, so you’re going to see the same [access] problem getting worse. But only the practices that can deliver on their promises will be able to survive.”

Working the New Model One of the keys to making the concierge model work is knowing how many of your current patients will make the switch, and understanding what your break-even point is. Golden explains that the doctors he’s seen fail are the ones who overestimate how many patients they’ll be able to retain. “And if you make that mistake and you’re only able to retain a very small percentage, obviously the model doesn’t work.”

Golden says that doctors need to understand that there’s a big difference between how their practice operates now and how it will need to operate under a concierge model. For example, patients expect certain things when they pay $1,500 and upward for membership, and the most important thing is access. “The reason people are willing to pay $1,500 is they feel that under their current scenario there’s no access, or that their medical care is rushed.”

Possibly the most important issue, Golden says, is for physicians to understand why they’re switching healthcare models. “They have to understand that they’re going to be spending more time with the patients, because that’s what the model really entails. And the question is, ‘Do you want to spend more time with patients?’ If you’re promising access, you really have to be accessible whenever.”

Not Recession Proof Despite their relative success, concierge medical practices are not flourishing everywhere. Martin Solomon, MD, medical director at Brigham and Women’s Primary Care of Brookline and assistant clinical professor in medicine at Harvard Medical School, says concierge practices in the Boston area are struggling. A major factor, he points out, is the economy.

“I know that there are people who have established concierge practices and they are losing patients,” Solomon says. “I don’t think the pool that they’re drawing patients from is as large as it was. And I think what’s happened is that after the initial rush, a lot of people have recognized that there’s no there there. They’re not really getting anything different because they don’t need much medical attention.”

Solomon, who admits he is not an advocate of concierge medicine, says that good primary care physicians already provide care as if every patient was a VIP. “Patients should be VIPs. And if you’re not able to [treat them like] that, then you need to restructure the way you’re practicing, and the number of patients you’re seeing.”

Middle Ground If you’re dissatisfied with your current practice model but hesitant to make the plunge into a full concierge model, there are options. One is the hybrid concierge model, which can be started with as few as 5% of your current patients joining. Concierge Choice Physicians is a New York-based company that helps physicians manage such a hybrid model. Wayne Lipton, the company’s managing director, says it’s a no-lose opportunity for doctors.

“When a doctor goes into the hybrid programs we’ve designed, what they have is a small portion of their day when the pace is less harried,” Lipton explains. “They can see a patient for a one-hour physical without being interrupted by other patient needs. It gives you a chance to better focus on not only the needs of the concierge patients, but the traditional patients as well.”

Lipton understands that going into a full concierge model can be risky and daunting. Falling short on the number of patients who join the new model by 10% or 15% could be disastrous. “That’s dangerous, because when you say goodbye to so many of your patients, you haven’t exactly ingratiated yourself in your community, so there’s no turning back. With a hybrid model, you’re never saying goodbye to your patients, so the assets you’ve built over the years still remain.”